Dear Readers,

Monica from Kingston 5, is a 34-year-old lady who, over the last year, has changed her lifestyle in an effort to become healthier. She is eating better, exercises regularly and she has lost weight! She has been walking and even jogging most evenings at Emancipation Park. She writes Lifeline as she is concerned that some of her toes feel sore and several toenails have lifted from the nail bed.

Some have fallen out over the last few months. Monica asks Lifeline why this is happening. Her shoes do not squeeze. She asks what she can do to prevent her toenail loss.

Walking is a wonderful exercise that burns calories and is associated with improved health. But regular walkers can experience toe problems. Proper fitting shoes are essential for walkers; otherwise the toes either bang about in the shoes (if the shoes are too big) or are squeezed, creating friction (if the shoes are too small), resulting in injury to the toes and their nails.

Walking in tight shoes creates both friction and a pressure which damages the toes. Stopping and starting too often while walking or walking a lot downhill can also drive the toes into the front of the shoes and injure them. Wearing socks which are too tight can also increase pressure on the toes and injure the nails. This condition develops because of the recurring pressure downwards on the toe- nails and the irritation occurring between the toes and the front of the shoe. During hot weather, the feet will swell in the shoes as we walk and create unusual friction. When these conditions prevail toe- nails can fall off.

Sometimes there is obvious bleeding under the toenails and the toes hurt. When bleeding occurs the pressure may have to be released from under the toenail by a physician. It usually takes several months for discoloured toenails to grow out. Other times the toes may feel a bit sore and the nails lift, off creating a space under the toe nail. At times, inflammatory secretions gather under a nail resulting in pressure and causing pain and discomfort until the inflammatory fluid is released. Once the toenail has been injured, an environment favouring secondary infection occurs and some individuals go on to develop toenail fungus which can be difficult to eradicate.

The main 'at risk' groups for this situation would be long distance runners, fast walkers, dancers, footballers and tennis players, as they constantly jar their toes into the front of their shoes. Over time and with repeated toe trauma, the toe- nails can become thickened (hyperkeratosis) and less attractive.

The separation of the nail plate from the nail bed (onycholysis) occurs because of repeated micro trauma to the toenails and usually occurs because of poor fitting shoes where the nails hit repeatedly on the front of the shoes. This also occurs in people with long toes. This lifting of the toenails is also commonly seen when toenail fungus (onychomycosis) has occurred. Because of this pressure and chronic micro injury to the nails, some people also experience a reduction in the nail plate resulting in reduced length and thickness of the 5th toenails and toenail deformity which a person can mistake for toenail fungus.

Symptoms of chronic toenail injury include:

Sore toes

Painful toes

Bleeding under the toenails

Dark discoloration of the toe-nail

Separation of the toenail from the nail bed

Partial of total loss of a toenail

Treatment involves the following:

Clip toenails so they do not make contact with the front of shoes worn. Trim in a straight line.

Wear square cut and rounded shoes rather than pointed toe shoes to remove pressure from toes

Tape a torn or elevated toenail for protection

Visit a doctor to drain off any blood or other inflammatory fluids present

Keep the toes clean and dry

Rest from the sporting activity for a few days to give inflammation a chance to settle

Often, if adverse conditions are correct (wear correct shoes) the injury will resolve itself

If pain or discoloration persists then see a doctor

n Get professional help when purchasing sports shoes and buy well-fitted shoes that keep moisture away from the skin and which allow the foot-room to breathe. Shoes should be at least half inch longer than the longest toe

Lace shoes more tightly when running downhill to prevent excessive movement of the feet in the shoes and prevent friction

Treat any secondary fungal toenail infection

A sore toe can affect how a person walks and even cause knee and back pain if occurring chronically, so this condition should not be ignored. Nevertheless, persist with exercise and walking, the plusses for good health far outweigh the possibility of a treatable toe condition!

Write to:

Lifeline,

PO Box 1731,

KGN 8

AJM